Study: Short-course antibiotic treatment effective for acute pyelonephritis

Older women with acute pyelonephritis can be successfully and safely treated with oral ciprofloxacin for 7 days, according to a study published online June 21 in The Lancet.
Acute pyelonephritis is a common and potentially serious infection in many women; however, few trials have assessed optimal treatment, according to Torsten Sandberg, of the Department of Infectious Diseases at Sahlgrenska University Hospital in Göteborg, Sweden, and colleagues.

The authors’ goal was to compare short-term efficacy and safety of a 7-day versus 14-day regimen. The prospective, randomized, double-blind, non-inferiority trial with parallel groups was conducted at 21 centers of infectious diseases in Sweden. This study was the first to compare the same antibiotic against identical daily doses for different durations.

Between Feb. 1, 2006, and Dec. 31, 2008, the investigators enrolled 248 women who were 18 years and older and were presumed to have acute pyelonephritis. The patients were randomly assigned to receive oral treatment with ciprofloxacin 500 mg twice daily for either 7 days or 14 days.

The results showed that cure rates were high for both regimens. Of the 126 patients who received treatment for 7 days, 73 were analyzed and 71 (97%) were cured. Of the 122 patients who received treatment for 14 days, 83 were analyzed and 80 (96%) were cured (difference –0.9%; 90% CI, –6.5 to 4.8; p=.004; non-inferiority test).

Both regimens were well-tolerated, and equally effective; however, the 14-day regimen was associated with more adverse events, the authors noted. Four (5%) of 86 patients who complied with study criteria and received 7 days of treatment and 6 (6%) of 93 assigned to 14 days reported an adverse event after the first week that may have been associated with the study drug. In those assigned to 7 days, no patient had mucosal candida infection after the first week versus 5 treated for 14 days (p=.036).

“Our results show that community-acquired acute pyelonephritis in women can be treated successfully and safely with oral ciprofloxacin for 7 days and even in older patients and those with a more severe infection,” the authors wrote. However, they caution that the results should not be extrapolated to other classes of antibiotics.